Percutaneous thecoperitoneal shunt for syringomyelia

Vengsarkar, Umesh S.; Panchal, Venilal G.; Tripathi, Parimal D.; Patkar, Sushil; Agarwal, Akhil; Doshi, Paresh K; Kamat, Manmohan

doi:10.3171/jns.1991.74.5.0827

Cited by 37 publications

(8 citation statements)

References 3 publications

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“…40,48,62,70,71 For cavities extending into the cervical cord, ventriculoperitoneal shunts have been used for the same purpose. 51,77 However, there exists little experience concerning the optimal pressure setting for such shunts.…”

Section: Surgical Managementmentioning

confidence: 99%

Treatment of posttraumatic syringomyelia

Klekamp¹

2012

SPI

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ObjectThis paper presents results of a prospective study for patients undergoing surgery for posttraumatic syringomyelia between 1991 and 2010.MethodsA group of 137 patients with posttraumatic syringomyelia were evaluated (mean age 45 ± 13 years, mean follow-up 51 ± 51 months) with pre- and postoperative MRI and clinical examinations presenting in this period and followed prospectively by outpatient visits and questionnaires. Surgery was recommended for symptomatic patients with a progressive course. Short-term results were determined within 3 months of surgery, whereas long-term outcomes in terms of clinical recurrences were studied with Kaplan-Meier statistics.ResultsThree groups were distinguished according to the type of trauma: Group A, patients with spinal trauma but without cord injury (ASIA E, n = 37); Group B, patients with an incomplete cord injury (ASIA C or D, n = 55); and Group C, patients with complete loss of motor function or a complete cord injury (ASIA A or B, n = 45). Overall, 61 patients with progressive symptoms underwent 71 operations. Of these operations, 61 consisted of arachnolysis, untethering, and duraplasty at the trauma level (that is, decompression), while 4 ASIA A patients underwent a cordectomy. The remaining procedures consisted of placement of a thecoperitoneal shunt, 2 opiate pump placements, and 2 anterior and 1 posterior cervical decompression and fusion. Seventy-six patients were not treated surgically due to lack of neurological progression or refusal of an operation. Neurological symptoms remained stable for 10 years in 84% of the patients for whom surgery was not recommended due to lack of neurological progression. In contrast, 60% of those who declined recommended surgery had neurological progression within 5 years. For patients presenting with neurological progression, outcome was better with decompression. Postoperatively, 61% demonstrated a reduction of syrinx size. Although neurological symptoms generally remained unchanged after surgery, 47% of affected patients reported a postoperative improvement of their pain syndrome. After 3 months, 51% considered their postoperative status improved and 41% considered it unchanged. In the long-term, favorable results were obtained for Groups A and C with rates for neurological deterioration of 6% and 14% after 5 years, respectively. In Group B, this rate was considerably higher at 39%, because arachnolysis and untethering to preserve residual cord function could not be fully achieved in all patients. Cordectomy led to neurological improvement and syrinx collapse in all 4 patients.ConclusionsThe technique of decompression with arachnolysis, untethering, and duraplasty at the level of the underlying trauma provides good long-term results for patients with progressive neurological symptoms following ASIA A, B and E injuries. Treatment of patients with posttraumatic syringomyelia after spinal cord injuries with preserved motor functions (ASIA C and D) remains a major challenge. Future studies will have to establish whether thecoperitoneal shunts would be a superior alternative for this subgroup.

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Section: Surgical Managementmentioning

confidence: 99%

Treatment of posttraumatic syringomyelia

Klekamp¹

2012

SPI

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“…Lumboperitoneal shunting is advocated by some authors for syringes [45, 67, 68], based on measurements of elevated lumbar spine pressure. However, this pressure theory has not been proven in cases of syringes associated with a Chiari I malformation and, when taken with the observation of cerebellar tonsillar descent after lumboperitoneal shunting [20, 69, 70, 71, 72, 73, 74], cannot be recommended as a primary procedure of choice.…”

Section: Discussionmentioning

confidence: 99%

Toward a Simpler Surgical Management of Chiari I Malformation in a Pediatric Population

Krieger

McComb

Levy³

1999

Pediatr Neurosurg

131

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A wide variety of surgical adjuvants to the standard bony decompression have been advocated in the treatment of the Chiari I malformation, especially when the tonsillar herniation is associated with hydrosyringomyelia. These include various shunting procedures, duroplasty, obex plugging, and resection of the cerebellar tonsils. Our practice has been to avoid these adjuvants and to perform a simple limited occipital craniectomy, C₁ laminectomy, and dural opening. The dura mater is left open and overlain with oxidized cellulose. To evaluate the efficacy of this more limited procedure, a retrospective review was performed of the medical records of 31 consecutive patients treated over a 6-year period. Twenty-six (84%) of these patients had an associated spinal cord syrinx; all underwent the same procedure. The follow-up period ranged from 15 to 93 months, with all patients having at least one postoperative magnetic resonance imaging at 6 months. Twenty-three of the 26 patients (88%) who presented with a syrinx had significant resolution of the syrinx on follow-up scans with concomitant improvement of presenting signs and symptoms. Of the remaining 3 patients, 1 had progressive hydrocephalus and received a ventriculoperitoneal shunt, with symptom resolution. In the other 2 patients the syrinx did not diminish; both received syringopleural shunts. Postoperative morbidity includes a 26% incidence of headaches, of which half resolved within 5 days, and only 1 persisted beyond 2 weeks. Nausea and vomiting occurred in 16%. Neither of these figures significantly exceeds those of other large surgical series in which the dura mater was closed with a patch graft. Three patients (10%) did have a postoperative cerebrospinal fluid leak; all responded to bedside suturing without further sequelae. This study indicates that a simple bone removal and open dural decompression of the cervicomedullary junction is a safe, effective operative treatment for Chiari I malformation in children. Shunts, duroplasty, obex plugging, and tonsillar resection offer no benefit regarding the outcome when our series is compared to others in which such adjuvants were used.

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“…Various cerebrospinal fluid diversion procedures, such as syringe-subarachnoidal, theco-peritoneal, syringe-pleural, and syringe-peritoneal shunting have been introduced recently, but most have been unreliable and have limitations2,3,9,13,15,16). Sgouros and Williams observed that a large proportion of patients with syringe-pleural shunts needed subsequent surgery within one year.…”

Section: Discussionmentioning

confidence: 99%

Syringo-Subarachnoid-Peritoneal Shunt Using T-Tube for Treatment of Post-Traumatic Syringomyelia

Kim

Choi

Youm

et al. 2012

J Korean Neurosurg Soc

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Various surgical procedures for the treatment of post-traumatic syringomyelia have been introduced recently, but most surgical strategies have been unreliable. We introduce the concept and technique of a new shunting procedure, syringo-subarachnoid-peritoneal shunt. A 54-year-old patient presented to our hospital with a progressive impairment of motion and position sense on the right side. Sixteen years before this admission, he had been treated by decompressive laminectomy for a burst fracture of L1. On his recent admission, magnetic resonance (MR) imaging studies of the whole spine revealed the presence of a huge syrinx extending from the medulla to the L1 vertebral level. We performed a syringo-subarachnoid-peritoneal shunt, including insertion of a T-tube into the syrinx, subarachnoid space and peritoneal cavity. Clinical manifestations and radiological findings improved after the operation. The syringo-subarachnoid-peritoneal shunt has several advantages. First, fluid can communicate freely between the syrinx, the subarachnoid space, and the peritoneal cavity. Secondly, we can prevent shunt catheter from migrating because dural anchoring of the T-tube is easy. Finally, we can perform shunt revision easily, because only one arm of the T-tube is inserted into the intraspinal syringx cavity. We think that this procedure is the most beneficial method among the various shunting procedures.

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Percutaneous thecoperitoneal shunt for syringomyelia

Cited by 37 publications

References 3 publications

Treatment of posttraumatic syringomyelia

Treatment of posttraumatic syringomyelia

Toward a Simpler Surgical Management of Chiari I Malformation in a Pediatric Population

Syringo-Subarachnoid-Peritoneal Shunt Using T-Tube for Treatment of Post-Traumatic Syringomyelia

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